Medicare's Power To Negotiate Drug Prices Will Harm Patients With Chronic Illnesses, Advocates Warn

Medicare Advantage's negotiating tool -- requiring patients to try lower-cost treatments before the more expensive ones -- is derided as a "fail first" process to those who oppose the strategy. “Consumers may have to go through one or more drugs before they can get a particular treatment they really need,” said Ellen Albritton, a senior policy analyst at Families USA. Meanwhile, there are already signals that implementing the new rules is going to be complicated.

The Hill: Patient Groups Rattled By New Medicare Power To Negotiate Lower Drug Prices

A new federal policy intended to drive down drug prices could have a negative effect on patients, particularly those with chronic conditions, according to health advocates. The policy announced Tuesday by the Department of Health and Human Services will give some private insurers the option to require patients try cheaper drugs before turning to more expensive ones, regardless of what their doctor prescribes. (Hellmann, 8/9)

Stat: Private Medicare Leverage Over Drug Costs Would Boost PBMs And Biosimilars

In its latest effort to attack high drug costs, the Trump administration wants to allow privately run Medicare Advantage plans to require patients to pursue step therapy, which means anyone who needs a costly, physician-administered drug must first try a cheaper medicine to see if it works. With about 19 million beneficiaries covered by these plans, the move is projected to save 15 percent to 20 percent of the $11.9 billion spent on Part B drugs, which are infused or injected medicines. Some of these are pricey specialty drugs for hard-to-treat diseases and ailments. (Silverman, 8/8)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

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